Prior authorization is also a data workflow. The CMS interoperability rule puts new attention on how that information moves between providers and impacted payers.
What CMS has finalized
The 2024 CMS-0057-F final rule sets operational requirements generally beginning in 2026 and API requirements generally beginning in 2027. Exact compliance dates depend on payer type. Its prior authorization provisions exclude drugs.
Beginning in 2026, impacted payers must provide specific reasons for prior authorization denials and publicly report certain metrics. The rule also sets 72-hour expedited and seven-calendar-day standard decision timeframes for impacted payers, excluding Qualified Health Plan issuers on the federally facilitated exchanges from those timeframes.
Source: CMS final-rule fact sheet, January 17, 2024.
A practical preparation lens
For revenue cycle teams, preparation can start with a workflow inventory. Where is an authorization stored? Who sees a denial reason? How is an expiration date carried into billing? Which details are copied by hand?
Documenting these handoffs gives operations and technical teams a shared starting point. Electronic exchange is more useful when the receiving workflow can turn the information into a clear next action.
What to ask your team
- Which payer workflows fall within the rule's scope?
- Can the system retain authorization status and the reason for an exception?
- Who validates the data after it reaches the billing workflow?
Policy summary reviewed September 6, 2026. Workflow suggestions are editorial analysis, not additional CMS requirements.